The fourth trimester is defined as the first 12 weeks postpartum. As recent research has shown, the fourth trimester is a critical period for both mom and baby, and therefore its complexity should not be overlooked. 

During this time, so many changes are occurring for new mothers from both a medical and psychosocial standpoint. Physically, this a period of recovery for the entire body and each woman experiences a unique combination of postpartum issues, including: abdominal pain, pelvic pain, weight fluctuations, hormonal shifts, urinary incontinence, etc. Mentally, women are battling sleep deprivation, fatigue, navigating motherhood, and hormonal shifts that could lead to an exacerbation of underlying anxiety/depression, or postpartum blues/ postpartum depression. Socially, women are adjusting to an entirely new lifestyle, including a different relationship with their partner and increased susceptibility to intimate partner violence, substance abuse, and other concerns. For breastfeeding women, there is an additional challenge of navigating the breastfeeding relationship, maintaining an adequate milk supply, and the complications associated with breastfeeding, including infections, clogged ducts, and breast abscesses. Although a time filled with so much joy, the realities of this period are serious and can lead to significant health concerns for women. 

The American College of Obstetricians and Gynecologists, or ACOG, has recognized this critical period and has placed more emphasis on individualized care by your Ob-Gyn provider. Traditionally, women would have one “6 week postpartum visit” and be “cleared” to return to normal life. ACOG acknowledges that this 6 week mark should be fluid, and that even though providers may medically “clear” someone to return to intercourse or physical activity, each woman is on their own timeline and should decide when the time is right for her. 

Additionally, ACOG recommends checking in with your OB provider within the first three weeks postpartum, either in person or virtually. Then a comprehensive postpartum visit, including full physical, social, and psychological assessment, should be performed no later than 12 weeks after birth. For women with pregnancy complications or underlying medical conditions, additional follow up may be necessary.

As someone experiencing the fourth trimester right now, I know personally how tough this time period is. My postpartum period has been challenged by postpartum pre eclampsia requiring hospital readmission, a difficult breastfeeding journey, and a newborn with acid reflux leading to a lot of sleepless nights and significant sleep deprivation. There have been days where I’ve cried, yelled, was physically in pain, all while feeling an intense love for this new tiny human. There have also been days where I haven’t felt totally connected to my baby due to the overwhelming nature of this period. All of these emotions are raw and real and I know that it’s ok to feel a myriad of different things. I’ve taken away that the most important way to stay physically and mentally sane is to lean on my support system, and at the end of the day to take a step back and try to enjoy this time as much as possible.

Please let me know about your experiences in the fourth trimester! How were you able to cope with the difficult days? Also please share your triumphs and your favorite memories.

With love,

Dr. Shweta Desai